Capillary refill time (CRT), also known as capillary filling time, is a clinically accepted measure of the amount of blood flow, or perfusion, to tissue occurring in a patient. It can provide a quick indication of how well the patient's vascular system is functioning, as well as the state of hydration/dehydration of the patient. A clinician typically measures capillary refill time by applying pressure to a fingernail or toenail of the patient until the nail bed under the fingernail or toenail turns white or blanches. This indicates that blood has been forced from the bed tissue. The pressure is then released and the time required for the nail bed tissue to regain its original color is measured. A time interval of two seconds or less is ordinarily taken as an indication that the patient's vascular system functioning and hydration is normal.
While apparatus is known in the prior art for carrying out the measurement of capillary refill time, as in U.S. Pat. No. 6,685,635, such apparatus has not found wide acceptance. Thus, at the present time in standard clinical practice, capillary refill time measurements are usually completely manual in nature. That is, the clinician must decide when to take a capillary refill time measurement, carry out the steps necessary to make the measurement, record or remember the measured capillary refill time, and, if applicable, trend the values over time. These circumstances increase the clinician's physical and mental workload and present opportunities for errors and omissions. The information is often in analog form, i.e. patient chart entries, so that collection and statistical treatment of the information by computer becomes more difficult.
Pulse oximetry is another commonly used technique for assessing the condition of a patient's circulatory system. Pulse oximetry measures the amount of oxygen in a patient's blood, specifically, the extent of oxygen saturation (SpO2) of arterial hemoglobin in the blood.
A pulse oximeter has two basic components. One is an electro-optical sensor, or probe, that is applied to the patient. A number of body locations may be used for this purpose. The probe may be placed on a finger or toe of the patient as well as on the nose, forehead, or earlobe of the patient can also be used. The probe has two light sources, each generating light of a different wavelength in the red-orange spectral range. The light is applied to patient's tissue and received by a light detector that measures the amount of light that has not been absorbed by blood hemoglobin in the tissue. The light detector is connected to the second component of the pulse oximeter, namely, a signal processor that computes oxygen saturation (SpO2) based on the ratio of the amount of light of each wavelength sensed by the detector. The signal processor distinguishes hemoglobin saturation in arterial blood from that in venous and capillary blood by sensing the pulsatile nature of the former thus giving rise to the term “pulse” oximetry.
Pulse oximeters have been used to provide an indication of tissue perfusion by taking the ratio of the pulsatile to non-pulsatile components in a plethysmographic signal of the pulse oximeter. Changes in the perfusion index (PI) so formed, over time, may quantify peripheral perfusion by indirectly monitoring changes in arterial blood flow. However, capillary refill time is a more direct and immediate measurement of tissue perfusion.
It would therefore be advantageous to have a single device that could measure multiple parameters relating to the vascular system of a patient, namely capillary refill time and arterial blood hemoglobin oxygen saturation.